Community-Based Interventions to Decrease Obesity and Tobacco Exposure and Reduce Health Care Costs: Outcome Estimates From Communities Putting Prevention to Work for 2010-2020.

INTRODUCTION: In 2010, the Centers for Disease Control and Prevention (CDC) launched Communities Putting Prevention to Work (CPPW), a $485 million program to reduce obesity, tobacco use, and exposure to secondhand smoke. CPPW awardees implemented evidence-based policy, systems, and environmental changes to sustain reductions in chronic disease risk factors. This article describes short-term and potential long-term benefits of the CPPW investment. METHODS: We used a mixed-methods approach to estimate population reach and to simulate the effects of completed CPPW interventions through 2020. Each awardee developed a community action plan. We linked plan objectives to a common set of interventions across awardees and estimated population reach as an early indicator of impact. We used the Prevention Impacts Simulation Model (PRISM), a systems dynamics model of cardiovascular disease prevention, to simulate premature deaths, health care costs, and productivity losses averted from 2010 through 2020 attributable to CPPW. RESULTS: Awardees completed 73% of their planned objectives. Sustained CPPW improvements may avert 14,000 premature deaths, $2.4 billion (in 2010 dollars) in discounted direct medical costs, and $9.5 billion (in 2010 dollars) in discounted lifetime and annual productivity losses through 2020. CONCLUSION: PRISM results suggest that large investments in community preventive interventions, if sustained, could yield cost savings many times greater than the original investment over 10 to 20 years and avert 14,000 premature deaths.

Strategic Planning for Chronic Disease Prevention in Rural America: Looking Through a PRISM Lens.

CONTEXT: Community-level strategic planning for chronic disease prevention. OBJECTIVE: To share the outcomes of the strategic planning process used by Mississippi Delta stakeholders to prevent and reduce the negative impacts of chronic disease in their communities. A key component of strategic planning was participants' use of the Prevention Impacts Simulation Model (PRISM) to project the reduction, compared with the status quo, in deaths and costs from implementing interventions in Mississippi Delta communities. DESIGN: Participants in Mississippi Delta strategic planning meetings used PRISM, a user-friendly, evidence-based simulation tool that includes 22 categories of policy, systems, and environmental change interventions, to pose what-if questions that explore the likely short- and long-term effects of an intervention or any desired combination of the 22 categories of chronic disease intervention programs and policies captured in PRISM. These categories address smoking, air pollution, poor nutrition, and lack of physical activity. Strategic planning participants used PRISM outputs to inform their decisions and actions to implement interventions. SETTING: Rural communities in the Mississippi Delta. PARTICIPANTS: A diverse group of 29 to 34 local chronic disease prevention stakeholders, known as the Mississippi Delta Strategic Alliance. MAIN OUTCOME MEASURE(S): Community plans and actions that were developed and implemented as a result of local strategic planning. RESULTS: Existing strategic planning efforts were complemented by the use of PRISM. The Mississippi Delta Strategic Alliance decided to implement new interventions to improve air quality and transportation and to expand existing interventions to reduce tobacco use and increase access to healthy foods. They also collaborated with the Department of Transportation to raise awareness and use of the current transportation network. CONCLUSIONS: The Mississippi Delta Strategic Alliance strategic planning process was complemented by the use of PRISM as a tool for strategic planning, which led to the implementation of new and strengthened chronic disease prevention interventions and policies in the Mississippi Delta.

Using simulation to compare 4 categories of intervention for reducing cardiovascular disease risks.

The Prevention Impacts Simulation Model (PRISM) projects the multiyear impacts of 22 different interventions aimed at reducing risk of cardiovascular disease. We grouped these into 4 categories: clinical, behavioral support, health promotion and access, and taxes and regulation. We simulated impacts for the United States overall and also for a less-advantaged county with a higher death rate. Of the 4 categories of intervention, taxes and regulation reduce costs the most in the short term (through 2020) and long term (through 2040) and reduce deaths the most in the long term; they are second to clinical interventions in reducing deaths in the short term. All 4 categories combined were required to bring costs and deaths in the less-advantaged county down to the national level.

Using simulation to compare established and emerging interventions to reduce cardiovascular disease risk in the United States.

INTRODUCTION: Computer simulation offers the ability to compare diverse interventions for reducing cardiovascular disease risks in a controlled and systematic way that cannot be done in the real world. METHODS: We used the Prevention Impacts Simulation Model (PRISM) to analyze the effect of 50 intervention levers, grouped into 6 (2 x 3) clusters on the basis of whether they were established or emerging and whether they acted in the policy domains of care (clinical, mental health, and behavioral services), air (smoking, secondhand smoke, and air pollution), or lifestyle (nutrition and physical activity). Uncertainty ranges were established through probabilistic sensitivity analysis. RESULTS: Results indicate that by 2040, all 6 intervention clusters combined could result in cumulative reductions of 49% to 54% in the cardiovascular risk-related death rate and of 13% to 21% in risk factor-attributable costs. A majority of the death reduction would come from Established interventions, but Emerging interventions would also contribute strongly. A slim majority of the cost reduction would come from Emerging interventions. CONCLUSION: PRISM allows public health officials to examine the potential influence of different types of interventions - both established and emerging - for reducing cardiovascular risks. Our modeling suggests that established interventions could still contribute much to reducing deaths and costs, especially through greater use of well-known approaches to preventive and acute clinical care, whereas emerging interventions have the potential to contribute significantly, especially through certain types of preventive care and improved nutrition.

From model to action: using a system dynamics model of chronic disease risks to align community action.

Health planners in Austin, Texas, are using a System Dynamics Model of Cardiovascular Disease Risks (SD model) to align prevention efforts and maximize the effect of limited resources. The SD model was developed using available evidence of disease prevalence, risk factors, local contextual factors, resulting health conditions, and their impact on population health. Given an interest in understanding opportunities for upstream health protection, the SD model focused on the portion of the population that has never had a cardiovascular event. Leaders in Austin used this interactive simulation model as a catalyst for convening diverse stakeholders in thinking about their strategic directions and policy priorities. Health officials shared insights from the model with a range of organizations in an effort to align actions and leverage assets in the community to promote healthier conditions for all. This article summarizes the results from several simulated intervention scenarios focusing specifically on conditions in East Travis County, an area marked by higher prevalence of adverse living conditions and related chronic diseases. The article also describes the formation of a new Chronic Disease Prevention Coalition in Austin, along with shifts in its members' perceived priorities for intervention both before and after interactions with the SD model.

Simulating and evaluating local interventions to improve cardiovascular health.

Numerous local interventions for cardiovascular disease are available, but resources to deliver them are limited. Identifying the most effective interventions is challenging because cardiovascular risks develop through causal pathways and gradual accumulations that defy simple calculation. We created a simulation model for evaluating multiple approaches to preventing and managing cardiovascular risks. The model incorporates data from many sources to represent all US adults who have never had a cardiovascular event. It simulates trajectories for the leading direct and indirect risk factors from 1990 to 2040 and evaluates 19 interventions. The main outcomes are first-time cardiovascular events and consequent deaths, as well as total consequence costs, which combine medical expenditures and productivity costs associated with cardiovascular events and risk factors. We used sensitivity analyses to examine the significance of uncertain parameters. A base case scenario shows that population turnover and aging strongly influence the future trajectories of several risk factors. At least 15 of 19 interventions are potentially cost saving and could reduce deaths from first cardiovascular events by approximately 20% and total consequence costs by 26%. Some interventions act quickly to reduce deaths, while others more gradually reduce costs related to risk factors. Although the model is still evolving, the simulated experiments reported here can inform policy and spending decisions.